Effects of Implementing Standardized Organizational Interventions on Drug Therapy Management (DTM): A Quasi-Experimental Study.

SUMMARY: Background. Interruptions occurring during the drug preparation and administration have a documented effect on patients' safety. However, literature has paid little attention to show how the introduction of a set of standardized organizational interventions, based on the combination of the current evidence, could reduce the number of interruptions occurring during drug therapy management. For this reason, this study used the most recent evidence to combine a set of standardized organizational interventions, and it was aimed to assess the effect of those interventions on the number of interruptions occurring during drug therapy management (Hypothesis a) and the overall duration of the therapy administration (Hypothesis b). Methods. A quasi-experimental study was performed, using pre- and a post- organizational implementation data collections in a single Italian center. The data collections were related to the interruptions and 40 shifts were randomly selected for both pre- and post-phase, respectively on December 2016 and February 2017. The standardized organizational interventions were implemented using the current evidence on this topic. Results. The standardized organizational interventions decreased the interruptions in the post-implementation phase, but those had not an effect on the duration of the therapy administration. Conclusions. This study represented an updated evidence, which describes the effect of a standardized and evidence-based set of organisational interventions' implementation on drug therapy management. Our results suggest a number of hints for managers and future researches. Managers should keep into account the usefulness of those interventions, while future researches with experimental designs are needed to provide harder evidence on this topic.

Validation of the Arabic Version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool.

BACKGROUND: Chemotherapy-induced peripheral neuropathy results in multidimensional neurological and muscular symptoms, which interfere with the patients' daily life. AIM: Examine the psychometric properties of the Arabic version of the chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) among adult cancer patients. METHOD: A descriptive study design was used. A convenience sample of 210 patients was assigned to two groups: 135 who received chemotherapies of known neurotoxic potential and 75 who served as a comparison group. Translation and back-translation considering cross-cultural issues to produce the Arabic version of CIPNAT was used. Test-retest and internal consistency reliability were used to test the reliability of the tool, whereas for the validity, content and construct validity were assessed. RESULTS: Test-retest scores for the overall scale (r = 0.98, p = < .001), for the symptom experience subscale (r = 0.97, p = <.001), and for the interference subscale (r = 0.96, p = < .001) all showed evidence of reliability. Cronbach α coefficients were 0.97, 0.96, and 0.95 for the total scores, symptoms experience, and interference scales, respectively. Items to total correlation ranged from moderate to strong (0.55-0.81). The Content Validity Index was 0.83. The data support the evidence of discriminant validity, as significant differences were found between the groups with regard to symptom experience (t = 8.51, p = < .001), interference (t = 5.60, p = <.001), and total score (t = 7.88, p = < .001). CONCLUSIONS: The Arabic version of CIPNAT showed adequate reliability and validity to screen for chemotherapy-induced peripheral neuropathy symptoms and their interference in Arab countries. Further studies are needed to evaluate concurrent validity.

Administração de medicamentos por via enteral: o saber e a práxis da enfermagem frente a resposta terapêutica / Administration of medicines through enteral: nursing knowledge and praxis in view of the therapeutic response / Administración de medicamentos a través de enteral: conocimiento de enfermería y praxis en vista de la respuesta terapéutica

Trata-se de um estudo descritivo de abordagem quantitativa. Teve como objetivos identificar e discutir o conhecimento da equipe de enfermagem na administração de medicamentos por via enteral quanto a resposta terapêutica na práxis da assistência de enfermagem. Foi realizado em quatro instituições hospitalares públicas, nas cidades de Cabo Frio e em Arraial do Cabo, no Estado do Rio de Janeiro, Brasil. Os sujeitos foram 103 profissionais da enfermagem, entre eles: enfermeiros, técnicos de enfermagem e auxiliares de enfermagem dos setores de clínica médica e cirúrgica. Os dados foram coletados no período entre fevereiro a abril 2019, através de questionário semiestruturado, e realizada a análise estatística descritiva dos dados. As implicações farmacêuticas, legais e técnicas do fornecimento de medicamentos via enteral não são amplamente compreendidas pela equipe de enfermagem. Verificou-se a necessidade de recomendar aos Conselhos de Enfermagem a elaboração de manuais e/ou protocolos com o intuito de evitar possíveis eventos adversos na administração de medicamentos por via enteral, aumentando a segurança e a eficácia da terapêutica em questão, auxiliando na redução de danos ao paciente.(AU)

Actions for safety in the prescription, use and administration of medications in emergency care units. / Ações para segurança na prescrição, uso e administração de medicamentos em unidades de pronto atendimento.

OBJECTIVE: To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team. METHOD: Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used. RESULTS AND DISCUSSION: From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions. CONCLUSION: The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.

Ações para segurança na prescrição, uso e administração de medicamentos em unidades de pronto atendimento / Acciones para la seguridad en la prescripción, consumo y administración de medicamentos en una unidad de pronta atención / Actions for safety in the prescription, use and administration of medications in emergency care units

Resumo OBJETIVO Identificar os riscos e incidentes relacionados ao processo de terapia medicamentosa no cenário de uma Unidade de Pronto Atendimento (UPA) e propor ações de gerenciamento e práticas seguras, na percepção da equipe de enfermagem. MÉTODO Pesquisa qualitativa, na modalidade pesquisa-ação, desenvolvida no cenário de uma UPA, localizada no interior de São Paulo. A coleta dos dados foi realizada por meio de entrevistas e grupos focais com 33 profissionais, entre junho de 2015 a abril de 2016. Para o tratamento dos dados utilizou-se a Técnica de Análise de Conteúdo. RESULTADOS E DISCUSSÃO A partir dos relatos dos participantes foram organizadas categorias temáticas, sendo os riscos e incidentes relacionados ao processo de terapia medicamentosa uma das categorias elencadas, assim como propostas de ações. CONCLUSÃO O estudo possibilitou a implementação de ações de segurança ao paciente relacionadas à administração de medicamentos em uma UPA, oferecendo maior qualidade do cuidado.

Resumen OBJETIVO Identificar cuáles son los riesgos e incidentes relacionados con el proceso de terapia medicamentosa en una Unidad de Pronta Atención (UPA) y presentar propuestas de acciones de gestión y prácticas seguras en la percepción del equipo de enfermería. MÉTODO Investigación cualitativa, en la modalidad investigación-acción, desarrollada en el escenario de una UPA, ubicada en el interior de San Pablo. Se recolectaron los datos a través de entrevistas y grupos focales con 33 profesionales, entre junio de 2015 y abril de 2016. Para procesar los datos, se utilizó la Técnica de Análisis de Contenido. RESULTADOS Y DISCUSIÓN A partir de los relatos de los participantes, se organizaron categorías temáticas, siendo los riesgos e incidentes relacionados al proceso de terapia medicamentosa una de las categorías enumeradas, así como las propuestas de acciones. CONCLUSIÓN El estudio permitió implementar acciones de seguridad del paciente relacionadas con la administración de medicamentos en una UPA, ofreciendo mayor calidad del cuidado.

ABSTRACT Objective: To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team. Method: Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used. Results and discussion: From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions. Conclusion: The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.

Cuidados com o paciente oncológico em tratamento quimioterápico: o conhecimento dos enfermeiros da Estratégia Saúde da Família / Care given to cancer patients undergoing chemotherapy: knowledge of family health strategy nurses / Cuidados prestados a los pacientes oncológicos sometidos a quimioterapia: conocimiento de los Profesionales en Enfermería de la Estrategia Salud de la Familia

Introdução: Os enfermeiros são os profissionais com maior contato com os pacientes oncológicos na atenção básica. A hipótese deste estudo é que existam lacunas de conhecimento desses profissionais sobre as particularidades no tratamento dos pacientes oncológicos. Objetivo: Identificar o nível de conhecimento de enfermeiros atuantes na Estratégia Saúde da Família (ESF), sobre os cuidados com o paciente oncológico durante o tratamento quimioterápico. Método: Estudo transversal, prospectivo, quantitativo, desenvolvido com 15 enfermeiros atuantes das ESF de três municípios do Norte do Estado do Rio Grande do Sul. Os dados foram coletados no mês de novembro de 2014, por meio da aplicação de questionário semiestruturado. Resultados: O nível geral de conhecimento foi classificado como escore regular. Apenas um entrevistado acertou 89% das questões, os demais não ultrapassaram o total de 67% das questões. O município Y obteve o maior número de acertos entre os participantes do estudo e também foi o único em que os enfermeiros eram 100% concursados e com o maior nível de formação profissional na população do estudo. Pode-se atribuir o melhor desempenho nas respostas ao maior nível de exigência na contratação dos enfermeiros. Conclusão: Existem lacunas no conhecimento dos enfermeiros para o atendimento aos pacientes portadores de neoplasias. Tal fator é limitante da prática profissional. É necessário investir nas capacitações e educação continuada para atingir um maior nível de conhecimento e, consequentemente, maior qualidade na atenção prestada aos pacientes oncológicos.

Introduction: Nurses are the professionals who have the greatest contact with cancer patients in primary care. Our hypothesis is that there are knowledge gaps about the particulars of the treatment of cancer patients in these professionals. Objective: To identify the level of knowledge of nurses working in the Family Health Strategy (FHS), on the care of cancer patients during chemotherapy. Method: Transversal, prospective study of quantitative nature, developed with 15 nurses working in Family Health Strategies of three municipalities in the north of the Rio Grande do Sul State. Data were collected in November 2014, by applying a semi structured questionnaire online. Results: The general level of knowledge was classified as regular. Only one respondent scored on 89% of the issues, and the others did not exceed the total of 67% of the questions. Y county had the highest number of correct responses of the study participants and was also the only one where nurses were gazetted and 100% with the highest level of training among the study population. You can assign the best performance in the answers to the most demanding level in the recruitment of nurses. Conclusion: There are gaps in the knowledge of nurses in caring for patients with cancer. This factor is limiting professional practice. We must invest in training and continuing education to achieve a higher level of knowledge and consequently, higher quality care provided to cancer patients.

Introducción: Los profecionales en enfermería tienen un mayor contacto con los pacientes de cáncer en la atención primaria. La hipótesis de este estúdio es que existen lagunas en los conocimientos de estos profesionales sobre las particularidads en el tratamento en pacientes con cáncer. Objetivo: Identificar el nivel de conocimiento de los profecionales en enfermería que trabajan en la Estrategia de Salud de la Familia (ESF), en el cuidado de los pacientes con cáncer durante la quimioterapia. Método: Estudio transversal, prospectivo de carácter cuantitativo, desarrollado con 15 enfermeros que trabajan con Estrategia de Salud de la Familia en tres municipios del norte del Estado Rio Grande do Sul los datos fueron recolectados en noviembre de 2014, mediante la aplicación semiestructurada de un cuestionario en línea. Resultados: El nivel general de conocimientos fue clasificado con un puntaje regular. Sólo uno de los encuestados alcanzó el 89% de los temas, los demás no superó el total de 67% de las preguntas. El municipio Y obtuvo el mayor número de aciertos entre los participantes del estudio y también fue el único donde los profesionales eran 100%, concursados y con el mayor nivel de formación profesional entre la población del estudio. Puede asignar el mejor rendimiento en las respuestas a un mayor nivel de exigencia en la contratación de personal de enfermería. Conclusión: Hay lagunas en el conocimiento de los profesionales de enfermería para el cuidado de pacientes portadores de neoplasias. Este factor está limitando la práctica profesional. Es necesario invertir en la capacitación y educación continua para lograr un mayor nivel de conocimiento y, en consecuencia, una atención de mayor calidad que se ofrece a los pacientes de cáncer.

Conhecimento da equipe de enfermagem acerca de eventos adversos do tratamento quimioterápico / Knowledge of a nursing team about chemotherapy adverse effects

Este estudo teve como objetivo identificar o conhecimento dos profissionais da equipe de enfermagem acerca dos eventos adversos decorrentes do tratamento quimioterápico. Estudo descritivo e transversal realizado entre março e maio de 2013 com 28 profissionais da equipe de enfermagem que trabalham no Ambulatório, na Unidade de Internação e na Central de Quimioterapia de um hospital universitário. Para a coleta dos dados foi utilizado um instrumento elaborado pelas autoras e validado por enfermeiras especialistas na área. Entre os participantes, 82,1% não possuem nenhum tipo de especialização na área de oncologia. As profissionais apresentaram dificuldades em classificar os eventos adversos em relação ao tempo de aparecimento, bem como ao manejo dos mesmos. Os eventos adversos relatados coincidem com os mais evidenciados na prática clínica. Diante da complexidade do tratamento quimioterápico, torna-se indiscutível a necessidade de capacitação dos profissionais de saúde que atuam na área quando consideramos uma prática assistencial em oncologia de qualidade.

This study aimed to identify the knowledge of the professional nursing team about the adverse events resulting from chemotherapy treatment. Descriptive cross-sectional study conducted between March and May 2013 with 28 professional nursing team working at the outpatient clinic, the inpatient unit and Chemotherapy Center of a university hospital. To collected data were used an instrument developed by the authors and validated by expertise nurses in this area. Among the participants, 82,1 % did not have any expertise in the area ofoncology. The professionals had difficulties in classifying adverse events in relation to time of onset, and their management. Reported adverse events coincide with the most evident in clinical practice. Given the complexity of chemotherapy becomes the indisputable need for training of health professionals working in the area when considering a care in oncology quality.

Symptom assessment in pediatric oncology: how should concordance between children's and parents' reports be evaluated?

BACKGROUND: Clinical evaluations in pediatric oncology are often triadic, involving children or adolescents, parents, and clinicians. However, few studies have evaluated the concordance between children's and parents' reports of symptom occurrence. OBJECTIVES: The purposes of this study were to evaluate the concordance between children's and parents' symptom reports during the week of chemotherapy administration using 5 statistical approaches and determine which factors are associated with higher levels of dyadic concordance. METHODS: Independent assessments of symptom occurrence were obtained from children and adolescents with cancer (n = 107) and their parents using the Memorial Symptom Assessment Scale 10-18. Concordance was assessed using (1) percentage of overall agreement, (2) Cohen κ coefficients, (3) McNemar tests, (4) positive percentage agreement, and (5) negative percentage agreement. RESULTS: For each dyad, an average of 20 of the 31 symptom reports were concordant. Using children's reports as the "gold standard," parents rarely underestimated the children's symptoms. However, compared with children's reports, parents overestimated 7 symptoms. Advantages and disadvantages of each of the statistical approaches used to evaluate concordance are described in this article. CONCLUSIONS: A variety of statistical approaches are needed to obtain a thorough evaluation of the concordance between symptom reports. Discordance was most common for symptoms that children refuted, particularly psychosocial symptoms. IMPLICATIONS FOR PRACTICE: Clinicians need to interview children and adolescents along with their parents about the occurrence of symptoms and evaluate discrepant reports. Effective approaches are needed to improve communication between children and parents to improve symptom assessment and management.

Medication administration in the domiciliary care setting: whose role?

Unqualified social care workers are increasingly delegated the responsibility of both assisting with and administering medication in the domiciliary care setting. This article discusses the considerations required before the delegation of these roles by both commissioners and nurses. In particular, variations in training, policies and provision are explored with reference to the Care Quality Commission guidance and Nursing and Midwifery Council standards. The levels of support and their definitions are clarified for use in policy documents, and the effectiveness of devices used to support self-care are critiqued within a legal framework. The importance of joint working to provide a seamless medication management service are highlighted using reflections on examples from practice.

Nursing best practices using automated dispensing cabinets: nurses' key role in improving medication safety.

Automated dispensing cabinets (ADCs) are used widely, but safety gaps remain. Nursing-pharmacy collaboration, expert guidance, self-assessment tools, compliance with nursing best practices, and continuing education are essential to optimize the safety and productivity of ADC use.

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a survey on forces, conditions and jurisdictional control.

BACKGROUND: The number of Western European and Anglo-Saxon countries where nurses are legally allowed to prescribe medicines is growing. As the prescribing of medicines has traditionally been the task of the medical profession, nurse prescribing is changing the relationship between the medical and nursing professions. OBJECTIVES: To gain more insight into the forces that led to the introduction of nurse prescribing of medicines in Western European and Anglo-Saxon countries, as well as into the legal, educational and organizational conditions under which nurses prescribe in these countries. Moreover, this study sought to determine which consequences nurse prescribing has for the division of jurisdictional control over prescribing between the nursing and medical professions. DESIGN: International survey. PARTICIPANTS: An email survey was sent to 60 stakeholders of professional nursing or medical associations or government bodies, at national, state or provincial level across ten Western European and Anglo-Saxon countries, namely Australia, Canada, Finland, Ireland, the Netherlands, New Zealand, Spain, Sweden, the United Kingdom and the United States of America. METHODS: The survey addressed the reasons for the introduction of nurse prescribing and the conditions under which nurses are or will be prescribing medicines. RESULTS: The response rate was 65% (n=39). It was shown that a diversity of forces led to the introduction of nurse prescribing, and respondents from nursing and medical associations and government bodies cited different forces as being important for the introduction of nurse prescribing. Representatives of nurses' associations oftentimes emphasized the medication needs of patients living in remote geographical areas, while representatives of medical associations more often pointed to workforce shortages within the health care service. The conditions under which nurses prescribe medicines vary considerably, from countries where nurses prescribe independently to countries in which prescribing by nurses is only allowed under strict conditions and the supervision of physicians. CONCLUSIONS: Citing different forces as being important in the introduction of nurse prescribing can be conceived as a professional 'problem construction' in order to gain jurisdiction over the prescribing task. In most countries, nurses prescribe in a subordinate position and the jurisdiction over prescribing remains predominantly with the medical profession.

Prescription of controlled drugs by non-medical prescribers.

The Government has again promised to end the confusion over the range and use of controlled drugs by non-medical prescribers (NMPs). A recent written answer suggests that regulations allowing district nurses who are NMPs to prescribe the full range of controlled drugs will be in place by the end of October 2011. This is the third time successive governments have made such a commitment, and until it is confirmed district nurses who are independent nurse prescribers must limit their use of controlled drugs to those set out in the British National Formulary and Drug Tariff. This article sets out the limitations on an independent nurse prescriber's right to prescribe controlled drugs under current legislation.

The diffusion of innovation in nursing regulatory policy: removing a barrier to medication administration training for child care providers.

Safe medication administration is an essential component of high-quality child care. Its achievement in New Jersey was impeded by a controversy over whether teaching child care providers medication administration involves registered nurses in the process of nursing delegation. Through the theoretical framework of the Diffusion of Innovation, this paper examines how the interpretation of regulatory policy related to nursing practice in New Jersey was adjusted by the Board of Nursing following a similar interpretation of regulatory policy by the Board of Nursing in Connecticut. This adjustment enabled New Jersey nurses to continue medication administration training for child care providers. National data supporting the need for training child care providers in medication administration is presented, the Diffusion of Innovation paradigm is described; the Connecticut case and the New Jersey dilemma are discussed; the diffusion process between the two states is analyzed and an assessment of the need for further change is made.

Extending the prescribing framework to nurses: lessons from the past.

This paper highlights the parallels between the journey to prescribing for nurse practitioners when the role was initially introduced in New Zealand and the journey now towards extending the prescribing framework to registered nurses. Nurse practitioners are the only nurses who can prescribe medicines, and their numbers are few. There are several thousand experienced registered nurses who meet the education requirements to be a nurse practitioner but who have not applied to the regulatory body for registration. Attention has begun to turn from this model, in which nurse practitioners are the only category of nurse who can prescribe, towards independent and supplementary nurse prescribing models. The New Zealand government is yet to fully commit to a specific plan for extending prescribing responsibilities to registered nurses, but feedback has been sought on two different proposals. Dependent prescribing arrangements used elsewhere appear to disregard the implications for professional autonomy. The proposed models of nurse prescribing for New Zealand impose oppressive restrictions, which nurse leaders over the last decade have fought hard to resist. Regulations are needed to allow nurses who have the appropriate education to be designated prescribers in their named area of specialisation. The difference between advanced practice nurses with prescribing rights and nurse practitioners must be clarified to minimise the impact of other prescribers on the nurse practitioner role. Lessons from the past and from the United Kingdom's experience could be drawn upon in order to better utilise the existing well-educated nursing workforce.

Towards IV drug standardization in critical care.

Local infusion practice within critical care has evolved over time, and one example of this is the wide variation in concentrations of drug infusions within critical care. While there are many similarities between critical care units, there are also many differences. Often drug infusions are used outside their product licence and, because of the diversity in practice, manufacturers are unlikely to license multiple preparations of even the most commonly used infusions. Critical care nurses spend many hours every day preparing and administering intravenous infusions. Much time could be saved if the infusions were available as a ready-to-use solution. This would also reduce the risk of errors that occur during the preparation and administration of medication infusions. This article describes a national project to achieve consensus on the strengths of drug infusions used within UK critical care units. Having agreed on standard solutions, it is hoped that manufacturers will seek licences for commonly used infusions and work towards mass production of these products. Off the shelf, ready-to-use infusions of commonly used medications could become a reality.